Growth factor membranes in treatment of multiple gingival recessions: a randomized clinical trial.

OBJECTIVE: The aim of this study was to assess the clinical effects of concentrated growth factor (CGF) in combination with coronally advanced flap (CAF) compared with platelet rich fibrin (PRF)+CAF for the treatment of multiple adjacent gingival recessions (GRs). METHOD AND MATERIALS: 18 subjects with total of 76 Type I GRs in the maxilla were included. Recessions were randomly treated according to a split-mouth design by means of CGF+CAF (39 defects, CGF side), or PRF+CAF (37 defects, PRF side). Clinical outcomes were evaluated at 6 months. RESULTS: The mean root coverage was 86.32% and 80.86%, and complete root coverage was 61.53% (24/39) and 51.35% (19/37) for CGF side and PRF side, respectively, at 6 months. Statistically significant gains were observed in the terms of clinical attachment level, recession depth, keratinized gingiva width, gingival thickness, and recession width in the both sides at 6 months compared to baseline values; no statistically significant difference was observed in these parameters between the two sides at 6 months. CONCLUSIONS: According to results, the use of CGF+CAF was not superior to PRF+CAF in providing additional benefits in clinical parameters. Keratinized gingiva width and gingival thickness significantly increased with the use of CGF and PRF membranes together with CAF.

Is periodontal disease a risk factor for developing severe Covid-19 infection? The potential role of Galectin-3.

IMPACT STATEMENT: There could be a close relationship between periodontal diseases (PDs) severity and Covid-19 infections. This relationship could be caused by Galectin-3-mediated increased immune response and increased viral attachment. Keeping PDs under control and maintaining rigorous oral hygiene during this troubled Covid-19 pandemic period is very important.Patients with older age and pre-existing conditions like cardiovascular disease, hypertension, diabetes, and obesity are in the higher risk group for developing severe Covid-19 infections. The inflammatory pathways that are involved in these conditions are the same pathways that we see in periodontal diseases (PDs). This raises a significant question: Is PD a pre-existing condition that can increase the risk of developing severe Covid-19 infection? Several studies have shown that Galectins play a key role in the homeostasis of immune cells, and recently, a relationship was found between Covid-19 and Galectin-3 (Gal-3).It has been determined that an important area in the spike protein of Coronavirus-19 is almost exactly the same as the morphology of Gal-3, and these spike proteins are critical for the entry of the virus into host cells. We suspect that there is enough evidence to support a close relationship between PDs severity and Covid-19 infections. There is accumulating evidence to suggest a relationship between the severity of PD and the risk of infection with Covid-19, which requires further investigation. This relationship could be caused by Gal-3-mediated increased immune response and increased viral attachment. In this context, we want to emphasize the importance of keeping PD under control by maintaining rigorous oral hygiene during this troubled Covid-19 pandemic period. We would also like to point out the possibility that having PD may be a pre-disposition toward developing a severe Covid-19 infection.

Impact of Three Different Education Methods on Oral Hygiene and Theoretical Knowledge of Schoolchildren

Objective: To evaluate the impact of three different education methods on the oral hygiene levels of school children using clinical and theoretical findings. Material and Methods: 144 children (72 males and 72 females), whose ages ranged between 8-13, were divided into 12 equal experimental groups according to their ages and gender. They were all considered to have poor hygiene. Only one out of the three different education methods (brochure, model or video) was applied to each group. The percentage change in PI, GI, BOP and theoretical test points from the baseline to the 6th months were evaluated. The data was statistically analysed by using Kolmogorov- Smirnov and One-way ANOVA tests. Results: Reduction in PI, GI and BOP scores was significantly greater (p<0.05) in the video applied groups compared to the brochure groups in the age of 8-10 groups for both genders and in 11-13-year-old males. In 11- 13-year-old females, all methods showed similar results (p>0.05). There was no significant difference in test points in 8-10 and 11-13-year-old female groups (p>0.05), whereas a significant increase in test points was observed in the video and model applied groups compared to the brochure groups in 8-10 and 11-13-year-old male groups (p<0.05). Conclusion: It may be more helpful and effective for children to get the oral hygiene education using the visual methods, especially for those under the age of ten.

Histological Evaluation of the Effect of Concentrated Growth Factor on Bone Healing.

OBJECTIVES: The aim of this study was to evaluate the effects of concentrated growth factors (CGF) on the healing of peri-implant bone defects in an animal model. STUDY DESIGN: Twenty 4-month-old New Zealand White rabbits, each with an average weight of 3.5 kg, were used in this blinded, prospective, experimental study. Two implants were placed and 2 peri-impant defects were prepared in each rabbit tibia. Bone defects were created monocortically in the tibia of each rabbit using a trephine burr with a diameter of 8 mm. The implants were installed in each hole. The rabbits were divided into 4 groups: in group E, the defect was left empty; in group CGF, the defects were filled only with CGF; in group AB, the defects were filled with autogenous bone; and in group AB+CGF, the defects were filled with autogenous bone and CGF. The animals were euthanized at week 8 postimplantation. All implants from the 20 animals were fixed in 10% formalin and evaluated histomorphometrically. RESULTS: The mean defect area was highest in group E and lowest in group CGF+AB (P <0.05). The area of the defect differed significantly between groups AB and CGF+AB (P <0.05), but not between groups CGF and E. Implant-to-bone contact was lowest in group E. In the defect areas of groups CGF, AB and CGF+AB, a small amount of new bone formed around the implant. CONCLUSIONS: In this animal model of a peri-implant bone defect, restoration was achieved using a combination of autogenous bone and CGF. Further studies are needed to determine the behavior of CGF when used in the repair of bone defects in humans.

Chemerin as a Novel Crevicular Fluid Marker of Patients With Periodontitis and Type 2 Diabetes Mellitus.

BACKGROUND: The objectives of the present study are to: 1) determine whether gingival crevicular fluid (GCF) chemerin is a novel predictive marker for patients with chronic periodontitis (CP) with and without type 2 diabetes mellitus (t2DM); 2) analyze the relationship between chemerin and interleukin (IL)-6 in periodontally healthy individuals and in patients with CP and with and without t2DM; and 3) evaluate the effect of non-surgical periodontal therapy on GCF chemerin levels. METHODS: Eighty individuals were split into four groups: 20 who were systemically and periodontally healthy (CTRL), 20 with t2DM and periodontally healthy (DM-CTRL), 20 systemically healthy with CP (CP), and 20 with CP and t2DM (DM-CP). Individuals with periodontitis were treated with non-surgical periodontal therapy. GCF sampling procedures and clinical periodontal measures were performed before and 6 weeks after treatment. Enzyme-linked immunosorbent assay was used to measure chemerin and IL-6 levels. RESULTS: Greater values for GCF chemerin and IL-6 levels were found in CP groups than in periodontally healthy groups, in DM-CP than in CP, and in DM-CTRL than in CTRL (P <0.008). GCF chemerin and IL-6 levels decreased following therapy in CP groups (P <0.02). A comprehensive overview of all groups showed a statistically significant positive correlation of chemerin with IL-6, glycated hemoglobin, sampled-site clinical attachment level, and gingival index (P <0.05). CONCLUSIONS: In this study, periodontitis and t2DM induced aberrant secretion of chemerin, and non-surgical periodontal therapy influenced the decrease of GCF chemerin levels in patients with CP with and without t2DM. Furthermore, it suggests GCF chemerin levels may be considered a potential proinflammatory marker for diabetes, periodontal disease, and treatment outcomes.

Gingival Crevicular Fluid Levels of Sclerostin, Osteoprotegerin, and Receptor Activator of Nuclear Factor-κB Ligand in Periodontitis.

BACKGROUND: To investigate changes in the levels and relative ratios of sclerostin, osteoprotegerin (OPG), and receptor activator of nuclear factor-κB ligand (RANKL) in the gingival crevicular fluid (GCF) of patients with periodontitis after non-surgical periodontal treatment. METHODS: Fifty-four individuals (27 healthy controls and 27 patients with chronic periodontitis [CP]) were enrolled in the study. Periodontitis patients received non-surgical periodontal therapy. GCF sampling and clinical periodontal parameters were assessed before and 6 weeks after therapy. Sclerostin, OPG, and RANKL levels were measured by enzyme-linked immunosorbent assay, and their relative ratios were calculated. RESULTS: Total amounts and concentrations of sclerostin were significantly higher in patients with CP than in healthy individuals (P <0.025) and decreased after treatment (P <0.05). The RANKL/OPG ratio was significantly lower in healthy individuals than in patients with periodontitis before and after treatment (P <0.025), but no significant difference was observed in patients with periodontitis after treatment (P >0.05). The sclerostin/OPG and sclerostin/RANKL ratios were significantly lower in healthy individuals than in patients with periodontitis before and after treatment (P <0.025) and decreased in patients with periodontitis after treatment (P <0.05). CONCLUSIONS: The GCF sclerostin level may be more reliable than the RANKL/OPG ratio as a diagnostic and prognostic marker of periodontal disease and treatment outcome. Regulation of sclerostin levels may aid the development of new therapeutic strategies for the treatment of periodontal disease.

Gingival crevicular fluid levels of neuropeptides following dental restorations.

PURPOSE: Local neuropeptide release has a critical role in the initiation and progression of an inflammatory response. This study investigated the effects of different restorative materials on periodontium in this regard, by evaluating their neuropeptide-producing effects on gingival crevicular fluid (GCF). METHODS: The study included 14 patients suitable for metal-ceramic, composite and amalgam restorations. Four weeks after periodontal therapy, the restorations were performed. Study groups were constituted regarding the tooth/restoration surfaces contacting gingiva in each patient: 1 ceramic surface of a metal-ceramic crown (ceramic group), its opposite metal surface (metal group), 1 composite surface (composite group), its opposite enamel surface (opposite-composite group), 1 amalgam surface (amalgam group), its opposite enamel surface (opposite-amalgam group) and 1 nonrestored enamel surface (enamel group). Four weeks after dental restorations, clinical data and GCF were obtained from the group sites. Clinical data, GCF volume and its proinflammatory cytokine profile were utilized to evaluate the periodontal health. GCF levels of substance P (SP), neurokinin A (NKA) and calcitonin-gene related peptide (CGRP) were determined by ELISA for revealing the neuropeptide levels. RESULTS: GCF volume was found to increase in all groups compared with the enamel group (p<0.05). SP and NKA levels were higher in the ceramic, composite and amalgam groups than those in the enamel group (p<0.05). SP and NKA levels were also higher in the composite and amalgam groups than those in the opposite-composite/amalgam groups (p<0.05). CONCLUSIONS: These results suggest that ceramic, composite and amalgam materials may uniquely trigger local neuropeptide release in periodontium.

8-hydroxy-deoxyguanosine levels in gingival crevicular fluid and saliva in patients with chronic periodontitis after initial periodontal treatment.

BACKGROUND: This study evaluates the effects of initial periodontal treatment on the gingival crevicular fluid (GCF) and salivary levels of 8-hydroxy-deoxyguanosine (8-OHdG) as a marker of oxidative deoxyribonucleic acid (DNA) damage in patients with chronic periodontitis (CP). METHODS: At baseline, clinical parameters were determined and GCF and saliva samples were obtained from 24 patients with CP and 24 individuals with clinically healthy periodontium. GCF, saliva samples, and clinical periodontal measurements were repeated at day 10, 1 month, and 3 months following initial periodontal therapy in patients with CP. 8-OHdG levels of GCF and saliva samples were investigated by using an enzyme-linked immunosorbent assay. RESULTS: Statistically significant higher 8-OHdG levels of GCF and a significant decrease after initial periodontal therapy were determined in the CP group (P <0.001). A significant positive correlation was found between 8-OHdG levels of GCF and clinical periodontal measurements (P <0.001). However, salivary levels of 8-OHdG did not differ between groups or during initial periodontal therapy (P >0.05). CONCLUSIONS: This study reveals that DNA injury and oxidative stress increase in tissue cells and especially in periodontal pockets in patients with CP, and the periodontal treatment results in a significant decrease of 8-OHdG levels in the GCF samples. To the best of our knowledge, this study evaluates for the first time, 8-OHdG levels in GCF, which is shown to be more useful as a biomarker than saliva. 8-OHdG was found to be important and may reveal the severity of periodontal disease and the effect of periodontal therapy.